Overview
Pubovaginal slings are the most common surgery used to treat stress urinary incontinence. A sling is a piece of material that is placed beneath the urethra to support and compress the urethra during activity.
There are a variety of surgical approaches to slings, including the traditional pubovaginal sling, the midurethral retropubic sling and the transobturator midurethral sling.
Most women with stress urinary incontinence have movement of the urethra away from the pubic bone when they increase abdominal pressure, such as during coughing or sneezing.
By compressing the urethra during these activities, the sling increases the resistance within the urethra to loss of urine. It is like stepping on a hose with running water and shutting the stream off.
Some slings are placed at the bladder neck and others at the mid-urethra. Some slings are secured to the abdominal wall or to the undersurface of the pubic bone, or rely on friction for anchoring.
Most surgeons performing these procedures use a synthetic sling that is placed through very small incisions in the vagina and lower abdomen. The recovery from these mid-urethral minimally invasive slings is typically a short period of time. In some cases, the procedures may be performed in an outpatient setting.
Considerations
Any women who is bothered by urine leakage with activities like coughing, laughing or sneezing. The procedure is also recommended if symptoms persist after pelvic floor exercises.
Effectiveness
The slings and retropubic colposuspension cure roughly 80 to 85 percent of patients two years following surgery. What’s more, an additional 10 percent of patients consider themselves significantly better. Cure is defined as never or rarely having leakage.
Five years after surgery, 60 percent remain dry, but nearly 80 percent remain satisfied with the results. Roughly nine percent of women will choose to undergo a repeat surgery within 15 years.
Risks
The risks of slings include injuring the bladder, urethra, bowel or pelvic vessels. Urinary retention (inability to void), urinary urgency, urge incontinence, and exposure of the sling material (extrusion). The most commonly reported complication is bladder injury and vaginal sling extrusion. Any other complications are rare. If you are considering having a sling procedure, please discuss these potential problems with your surgeon.